Diet Therapy in Pediatric Eosinophilic Esophagitis: A Pathway to Histologic Remission

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disorder triggered by food and environmental allergens. Over time, chronic esophageal inflammation can lead to stricturing disease. Current EoE therapies include proton pump inhibitors, swallowed corticosteroids, diet therapy, and biologics. Of these modalities, diet therapy aims to prevent and treat inflammation by removing food triggers from the diet. In this article, the author reviewed both elemental diets and the various types of empiric food elimination diets. Diet therapy may be an option for families seeking alternatives to medication, while offering comparable efficacy depending on the diet. A step-up strategy (ie, starting with 1- or 2-food elimination) is a common first step in diet therapy, helping to minimize dietary restriction and reduce the number of endoscopies required for disease monitoring. Unfortunately, no existing serum or tissue sampling test can accurately identify a food trigger prior to elimination therapy. As such, future advancements in efficacious, noninvasive methods could prove beneficial for individualizing diet therapies, improving adherence, and minimizing treatment risks.